Tenn. Comp. R. & Regs. 1240-07-10-.12 - STAFFING AND SUPERVISION

(1) General Staff Requirements.

(a) At least one staff member who can read, write, and speak English shall always be available on site.

(b) A minimum of seventy-five percent (75%) of persons included in the staff:participant ratio shall have a high school diploma or GED.

(c) Age requirements.

1. Except as provided in part 2. below, all employees and volunteers shall be at least eighteen (18) years of age.

2. Students enrolled in high school who are at least fourteen (14) years of age:

(i) May provide office or administrative services to the center;

(ii) May provide companionship services for the participants but may not be left alone without the presence of at least one qualified staff member, eighteen (18) years of age or older;

(iii) May not supervise staff or volunteers; and

(iv) Shall not be counted in the staff:participant ratio.

(d) A volunteer shall not be used to meet the staff:participant ratio unless his/her education and training meets the minimum qualifications required of direct care staff and he/she meets the background check requirements contained in these rules. A name, address, telephone number(s), and dates of service shall be recorded for each volunteer in the personnel records of the center.

(e) There shall be present at all times at least one (1) direct care staff person who is trained and certified in cardiopulmonary resuscitation (CPR) and trained in first aid, the Heimlich maneuver, and the center's fire, safety, and emergency plans.

(f) In the absence of the director, an assistant director or other staff member shall act in the place of the director, and all staff shall be notified of this designation.

(g) Each center shall maintain an organizational chart for the facility and any updates will be provided to the Department.

(2) Director Qualifications.

(a) The director of the adult day services center shall have one or more of the following qualifications:

1. A minimum of a bachelor's degree in social services, health, and/or related fields and one (1) year of experience working in social services, health, and/or related fields; or

2. A minimum of a bachelor's or master's degree (not related to social services, health, or related fields) with two (2) years work experience in social services, health and/or related fields; or

3. Sixty (60) semester hours (formal college training) in social services, health, and/or related fields and two (2) years of work experience in social services, health and/or related fields; or

4. A minimum of a master's degree in health, social services, and/or related fields; or

5. A high school diploma or its equivalent, and five (5) years of full time work experience (in a managerial capacity) in social services, health and/or related fields.

(b) An adult day services center located on the premises of, and operated by, a sponsoring facility consisting of either a licensed nursing home, a licensed hospital, a licensed assisted-care living facility, a licensed home for the aged, or licensed residential hospice, shall comply with all adult day services licensing requirements.

(3) Training.

(a) Prior to assuming duties and responsibilities all staff, whether paid or unpaid, shall complete Department-recognized training on universal precautions, fire safety, emergency plans, infection control and infectious diseases; and Department-recognized training on the signs and symptoms of abuse, neglect or exploitation of an adult as specified by T.C.A. §§ 71-6-102 et seq., as well as the duty to report to the Department any abuse, neglect or exploitation of an adult as required by T.C.A. § 71-6103.

(b) All staff shall complete eight (8) hours of Department-recognized annual training relevant to the performance of their duties and related to the population served, the behaviors of the population served, infection control and infectious diseases and other such relevant training.

(c) Within thirty (30) days of beginning his/her duties, each staff person shall complete Department-recognized training on the signs and symptoms of abuse, neglect or exploitation of an adult as specified by T.C.A. §§ 71-6-102 et seq., as well as the duty to report to the Department any abuse, neglect or exploitation of an adult as required by T.C.A. § 71-6-103.

(4) Staff Records.

(a) An employment record shall be maintained on site for each current employee and volunteer included in the staff of the adult day services center.

(b) Hard copy or electronic files are acceptable to meet the record requirements of this paragraph.

(c) An employment record shall be maintained by the center for at least one (1) year after cessation of employment or volunteer service.

(d) An employment record for each employee and volunteer used to meet ratios shall include the following:

1. Name, telephone number, and all addresses associated with the individual, both residential and employment-related, within the twelve (12) month period prior to the hiring as an employee or acceptance as a volunteer;

2. Signed and completed criminal history disclosure form;

3. Background check clearance letter;

4. Evidence of educational background;

5. Employment history;

6. Documented verification of three (3) non-relative references;

7. Job description;

8. Annual performance evaluation;

9. Verification of required training hours; and

10. A person to be notified in case of an emergency involving the employee or volunteer.

(5) Staffing Patterns.

(a) Staff of the center shall be adequate in number and skill to ensure the safety and proper supervision of the participants, meet the individual support needs of the participants, and to carry out the objectives of the center.

(b) The direct care staff to participant ratio shall consist of at least one (1) direct care staff person for every eight (8) participants. The required number of direct care staff shall be maintained onsite.

1. Staff may assist participants with tasks as needed apart from the group, and participants may engage in activities beyond the sight of staff.

2. Staff shall know the whereabouts of participants and provide a level of supervision consistent with the needs of the participant.

(c) Volunteers may be considered in determining direct care staff:participant ratios; provided that the volunteer's education and training meet the minimum qualifications required of direct care staff. Volunteers who do not meet these minimal requirements may not be counted in the required ratio and shall always be directly supervised by at least one (1) responsible paid direct care staff member, but may assist staff and other qualified volunteers subject to the criminal background requirements set forth in this rule and T.C.A. § 71-2-403.

(6) Responsibility of Center for Supervision of Participants.

(a) The director of the center shall maintain a system of supervision that ensures the participant's autonomy and freedom of choice:

1. Is appropriate to each participant's individual needs;

2. Ensures each participant's health and safety; and

3. Allows center personnel to know the whereabouts of each participant and to allow for immediate physical access.

(b) The system shall include a mandatory visual inspection of all areas of the building and grounds immediately prior to closing the center for the day in order to ensure that no participant has remained in any part of the center's facilities.

(c) Devices such as mirrors, video equipment used for live stream viewing, electronic sound monitors, etc. may be used as appropriate to assist the supervision requirements.

(d) Staff shall be aware of each participant's personal care needs while respecting the privacy of the participant.

(e) Required Staff:Participant Ratios.

1. The center shall have a plan that enables staff, in an emergency situation, to access additional staff who can respond quickly in order to maintain the required staff:participant ratio.

2. The minimum required staff:participant ratio must be increased by at least one (1) staff member during off-site activities, and then increased, as necessary, to meet any special needs of each participant and to provide adequate supervision.

Notes

Tenn. Comp. R. & Regs. 1240-07-10-.12

Original rule filed December 14, 1999; effective 2/27/2000. Repeal and new rule filed February 23, 2018; effective 5/24/2018. Amendments filed October 25, 2022; effective 1/23/2023.

Authority: T.C.A. §§ 4-5-201, et seq.; and 71-2-401, et seq.